1- Cutaneous muscle flap.

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After its description in the early 1980s, the transverse rectus abdominis cutaneous muscle (TRAM) flap became an important technique in breast reconstruction, both immediate and late.

Breast reconstruction techniques have evolved in parallel with oncological surgical approaches in the treatment of breast cancer. In the 1980s, radical mastectomies made the TRAM the “gold standard” technique for reconstructions. Currently, factors such as early diagnosis and neoadjuvant chemotherapy with new drugs allow mastectomy techniques to be more conservative. The frequent preservation of skin coverage and pectoral muscles turned the TRAM into a second option.

The excess dermofat from the lower abdomen can be transferred to the pedicled thorax in vessels that originate in the deep superior epigastric artery and vein (mono or bipedicled TRAM), deep inferior epigastric (free TRAM or perforating flap) or superficial inferior epigastric artery. (SIEA flap)

                                Reconstruction with a rectus abdominis muscle flap

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Breast reconstruction with TRAM is a major surgery that can prolong the length of stay. For this reason, many patients choose simpler techniques, such as the use of implants and expanders

In situations where there is a need for flap rotation associated with the inclusion of an implant, the latissimus dorsi muscle is a great option due to its anatomy.

The latissimus dorsi is a broad, thin, and superficial muscle located in the posterior thoracic region. It has a triangular shape and its lower limit is the iliac crest, its upper limit is the tip of the scapula, and its medial limit is the thoracolumbar fascia. The lateral edge is free and forms the posterior limit of the axillary region.

The skin segment can be demarcated in various directions as shown in the drawing below. The best positioned scar is the one located in the posterior extension of the inflammatory sulcus, as clothing may cover it in the region.

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                            Reconstruction with latissimus dorsi muscle flap